The Department of Health (DH) and UK Trade and Investment want more leading hospitals to follow the example of world renowned institutions such as Moorfields eye hospital and Great Ormond Street children's hospital by establishing franchises abroad.

International work is not a luxury for the good times; it is key to the future of the NHS. Healthcare can mount a strong claim to be the most global of industries. New techniques spread with extraordinary speed. While technology firms and pharmaceutical companies hoard their inventions behind walls of patents, doctors and other healthcare practitioners shout their research results and clinical trials (the successful ones, at least) from the pages of peer-reviewed journals and the platforms of international symposia. This global network drives progress in the best NHS hospitals.

While there are corners of the NHS which perform poorly by national and even regional standards, the best clinical teams in the country benchmark their survival rates and other performance measures internationally. Directly competing with other world class healthcare teams will encourage our best hospitals to stay at the forefront of modern practice, to the benefit of NHS patients.

Working internationally need not be a distraction from the pursuit of greater productivity at home. Indeed, some of the most exciting developments in countries such as India and Brazil are focused on delivering high quality at low cost. The Aravind eye care system in India is just one example from which the NHS can learn. The NHS as a whole is often slow to adopt new approaches to care; more international work can help push reform through the system.

So there is more to setting up NHS facilities abroad than simply the money. The additional income will, be useful, of course, helping fund innovation and research as well as more routine activities. But the DH and the NHS Confederation should be more open about the financial risks and address the issue of distracting hospitals from NHS care.

As trusts struggle to cope with falling income and the cash freeze in NHS spending stretches into the far distance, it would be understandable for senior clinicians and managers to focus their efforts on developing a shiny new institution abroad rather than deal with the less glamorous frustrations back home. And, since these ventures will be funded by private patient income, will that further distort priorities? The risk of distraction is real and cannot be wished away. Rigorous board oversight will be essential to ensure clinical and management focus on the core service does not diminish.

The financial risks are significant. The capital investment in technologically advanced healthcare facilities can be expected to be substantial, hospital building projects have been known to go over budget, and the running costs are likely to be high. The financial rewards will be uncertain and are unlikely to look impressive compared with total NHS spending.

Simply saying the expenditure will be ringfenced from NHS funds sounds unconvincing. If money can flow in, it doesn't take much imagination to believe it could also flow out if what seemed a good idea in England turns out to be less appealing in Abu Dhabi.

But if the risks are faced up to and managed, the long-term benefits to NHS patients of more international collaboration could be substantial. Hunkering down and saying the health service has not got time to work abroad is the creed of inertia. Faster improvement in patient care must be the overriding goal.